{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T20:18:20Z","timestamp":1793823500059,"version":"4.6.1"},"reference-count":79,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"9","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Precis Oncol"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n            <jats:title>PURPOSE<\/jats:title>\n            <jats:p>\n              Targeted therapy and immunotherapy promise improved survival in patients with advanced melanoma, yet the effectiveness and cost-effectiveness of multigene panel sequencing compared with single-gene\n              <jats:italic>BRAF<\/jats:italic>\n              testing to guide therapeutic decisions is unknown.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS<\/jats:title>\n            <jats:p>\n              Our population-based quasi-experimental retrospective target trial emulation used comprehensive patient-level data for 364 British Columbia, Canada, adults with an advanced melanoma diagnosis receiving multigene panel sequencing or single-gene\n              <jats:italic>BRAF<\/jats:italic>\n              testing between September 1, 2016, and December 31, 2018. We 1:1 matched multigene panel patients to controls using genetic algorithm\u2013based matching. Outcomes included 3-year overall survival (OS) and health care costs (2021 Canadian dollars [CAD]) with incremental net monetary benefit for life-years gained (LYG). Outcomes were analyzed using inverse probability of censoring weighted linear regression for the intention-to-treat (ITT) effect. The per-protocol (PP) effect estimation also included stabilized inverse probability of treatment weights. We then used Weibull regression and Kaplan-Meier survival analysis.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS<\/jats:title>\n            <jats:p>\n              We matched 147 multigene panel patients to controls, achieving balance for all covariates. After matching, ITT incremental costs were $19,447 CAD (95% CI, -$19,045 to $50,683) and incremental LYG were 0.22 (95% CI, \u20130.05 to 0.49). We found uncertainty in differences on OS using Kaplan-Meier (\n              <jats:italic>P<\/jats:italic>\n              = .11) and Weibull regression (hazard ratio [HR], 0.73 [95% CI, 0.51 to 1.03]) in the ITT. PP incremental costs were $25,457 CAD (95% CI, \u2013$5,856 to $59,490) and incremental LYG were 0.39 (95% CI, 0.02 to 0.85), with corresponding differences in OS using Kaplan-Meier (\n              <jats:italic>P<\/jats:italic>\n              = .06) and Weibull regression (HR, 0.62 [95% CI, 0.40 to 0.97]). The probability of multigene panels being cost-effective at $100,000\/LYG CAD was 53% for ITT and 74% for PP.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSION<\/jats:title>\n            <jats:p>The cost-effectiveness of multigene panels was evenly poised at higher thresholds, even when accounting for treatment initiation. Health systems reimbursing multigene panels and expensive therapies may be confronted with a value tradeoff, in which there may be improved survival albeit with a modest change in cost-effectiveness.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1200\/po-24-00631","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T20:59:11Z","timestamp":1740171551000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Effectiveness and Cost-Effectiveness of Multigene Panel Sequencing in Advanced Melanoma: A Population-Level Real-World Target Trial Emulation"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6590-8728","authenticated-orcid":true,"given":"Emanuel","family":"Krebs","sequence":"first","affiliation":[{"name":"Cancer Control Research, BC Cancer Research Institute, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3072-5657","authenticated-orcid":true,"given":"Deirdre","family":"Weymann","sequence":"additional","affiliation":[{"name":"Cancer Control Research, BC Cancer Research Institute, Vancouver, BC, Canada"},{"name":"Faculty of Health Sciences, Simon Fraser University, Vancouver, BC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5922-3984","authenticated-orcid":true,"given":"Cheryl","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada"},{"name":"Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Weppler","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada"},{"name":"Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4739-007X","authenticated-orcid":true,"given":"Ian","family":"Bosdet","sequence":"additional","affiliation":[{"name":"Department of Pathology &amp; 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